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General NPI Number Information
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NPI Number | 1184571168
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Entity Type | Individual
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Provider Name | JESSICA LEIGH POULIN
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Gender | Female
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 1 ESSEX CENTER DR
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City | PEABODY
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State | MA
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Zip | 01960-2901
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Country | US
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Telephone | 978-538-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 106 DRAKE RD
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City | BURLINGTON
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State | MA
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Zip | 01803-1839
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Country | US
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Telephone | 339-234-1986
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LDN8343
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License Number State | MA
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